DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and Health ( N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16–0.56); social problems (aOR = 0.46, 95% CI = 0.30–0.71); given-up activities (aOR = 0.66, 95% CI = 0.47–0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34–0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37–0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01–0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20–0.73 for criterion A and aOR = 0.16, 95% CI = 0.05–0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults’ social context may be needed for accurate diagnosis.